Autopsy and Case Reports
Autopsy and Case Reports
Article / Autopsy Case Report

Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome

Gabriel Núncio Benevides; German Alcoba Salgado Jr; Cristiane Rúbia Ferreira; Aloísio Felipe-Silva; Alfredo Elias Gilio

Downloads: 27
Views: 1288


The symptoms of a previously healthy 14-year-old female with an initial history of tooth pain and swelling of the left maxillary evolved to a progressive headache and altered neurological findings characterized by auditory hallucinations, sleep disturbances, and aggressiveness. She was brought to the emergency department after 21 days of the initial symptoms. An initial computed tomography (CT) scan showed frontal subdural empyema with bone erosion. The symptoms continued to evolve to brain herniation 24 hours after admission. A second CT scan showed a left internal jugular vein thrombosis. The outcome was unfavorable and the patient died on the second day after admission. The autopsy findings depicted rarefaction of the cranial bone at the left side of the frontal sinus, and overt meningitis. The severe infection was further complicated by thrombophlebitis of the left internal jugular vein up to the superior vena cava with septic embolization to the lungs, pneumonia, and sepsis. This case report highlights the degree of severity that a trivial infection can reach. The unusual presentation of the sinusitis may have wrongly guided the approach of this unfortunate case.


Sinusitis, Empyema, Subdural, Meningoencephalitis, Adolescent


Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72-e112. []. [PMID:22438350]

Zaman K, Baqui AH, Yunus M, et al. Acute respiratory infections in children: a community-based longitudinal study in rural Bangladesh. J Trop Pediatr. 1997;43(3):133-7. []. [PMID:9231631]

Chonmaitree T, Revai K, Grady JJ, et al. Viral upper respiratory tract infection and otitis media complication in young children. Clin Infect Dis. 2008;46(6):815-23. 18279042.

Wald R, Guerra N, Byers C. Upper respiratory children: duration complications. Pediatrics. 1991;87(2):129-33. [PMID:1987522]

Gwaltney JM Jr, Wiesinger BA, Patrie JT. Acute community‐acquired bacterial sinusitis: the value of antimicrobial treatment and the natural history. Clin Infect Dis. 2004;38(2):227-33. []. [PMID:14699455]

Marom T, Alvarez-Fernandez PE, Jennings K, Patel JA, McCormick DP, Chonmaitree T. Acute bacterial sinusitis complicating viral upper respiratory tract infection in young children. Pediatr Infect Dis J. 2014;33(8):803-8. []. [PMID:24717966]

Dankbaar JW, van Bemmel AJM, Pameijer FA. Imaging findings of the orbital and intracranial complications of acute bacterial rhinosinusitis. Insights Imaging. 2015;6(5):509-18. []. [PMID:26253983]

Chaiyasate S, Fooanant S, Navacharoen N, Roongrotwattanasiri K, Tantilipikorn P, Patumanond J. The complications of sinusitis in a tertiary care hospital: types, patient characteristics, and outcomes. Int J Otolaryngol. 2015:1-5.

Schlemmer KD, Naidoo SK. Complicated sinusitis in a developing country, a retrospective review. Int J Pediatr Otorhinolaryngol. 2013;77(7):1174-8. []. [PMID:23688379].

Bayonne E, Kania R, Tran P, Huy B, Herman P. Intracranial complications of rhinosinusitis. a review, typical imaging data and algorithm of management. Rhinology. 2009;47(1):59-65. [PMID:19382497]

Hakim H El, Malik AC, Aronyk K, Ledi E, Bhargava R. The prevalence of intracranial complications in pediatric frontal sinusitis. Int J Pediatr Otorhinolaryngol. 2006;70(8):1383-7. [PMID:16530852].

Herrmann BW, Chung JC, Eisenbeis JF, Forsen JW Jr. Intracranial complications of pediatric frontal rhinosinusitis. Otolaryngol Head Neck Surg. 2006;20(3):320-5. [PMID:16871937]

Quraishi H, Zevallos JP. Subdural empyema as a complication of sinusitis in the pediatric population. Int J Pediatr Otorhinolaryngol. 2006;70(9):1581-6. []. [PMID:16777239]

Calik M, Iscan A, Abuhandan M, Yetkin I, Bozkuş F, Torun MF. Masked subdural empyema secondary to frontal sinusitis. Am J Emerg Med. 2012;30(8):1657.e1-4. 22030191.

French H, Schaefer N, Keijzers G, Barison D, Olson S. Intracranial subdural empyema: a 10-year case series. Ochsner J. 2014;14(2):188-94. [PMID:24940128]

Kombogiorgas D, Seth R, Athwal R, Modha J, Singh J. Suppurative intracranial complications of sinusitis in adolescence. Single institute experience and review of literature. Br J Neurosurg. 2007;21(6):603-9. []. [PMID:18071989]

Hicks CW, Weber JG, Reid JR, Moodley M. Identifying and managing intracranial complications of sinusitis in children: a retrospective series. Pediatr Infect Dis J. 2011;30(3):222-6. []. [PMID:21416657]

Skelton R, Maixner W, Isaacs D, Skelton R. Sinusitis-induced subdural. Arch Dis Child. 1992;67(12):1478-80.

Triulzi F, Zirpoli S. Imaging techniques in the diagnosis and management of rhinosinusitis in children. Pediatr Allergy Immunol. 2007;18(Suppl 18):46-9. []. [PMID:17767608]

DeMuri GP, Wald ER. Clinical practice. Acute bacterial sinusitis in children. N Engl J Med. 2012;367(12):1128-34. [PMID:22992076]

Derin S, Sahan M, Hazer DB, Sahan L. Subdural empyema and unilateral pansinusitis due to a tooth infection. BMJ Case Rep. 2015; pii: bcr2014207666. []. [PMID:26123452]

Simuntis R, Kubilius R, Vaitkus S. Odontogenic maxillary sinusitis: a review. Stomatologija. 2014;16(2):39-43. [PMID:25209225]

Martines F, Salvago P, Ferrara S, Mucia M, Gambino A, Sireci F. Parietal subdural empyema as complication of acute odontogenic sinusitis: a case report. J Med Case Rep. 2014;8(1):282. []. [PMID:25146384]

Kastner J. Orbital and intracranial complications after acute rhinosinusitis. Neuroimaging Clin N Am. 2010;20(4):511-26. [].

Hoskison E, Daniel M, Rowson JE, Jones NS. Evidence of an increase in the incidence of odontogenic sinusitis over the last decade in the UK. J Laryngol Otol. 2012;126(1):43-6. []. [PMID:21933468]

Lemierre A. On certain septicæmias due to anaerobic organisms. Lancet. 1936;227(5874):701-3. [].

Riordan T. Human infection with Fusobacterium necrophorum (Necrobacillosis), with a focus on Lemierre’s syndrome. Clin Microbiol Rev. 2007;20(4):622-59. []. [PMID:17934077]

Bouziri A, Douira W, Khaldi A, et al. Neurological variant of Lemierre’s Syndrome with purulent meningitis: a case report and literature review. Fetal Pediatr Pathol. 2013;31(1):1-6. []. [PMID:22506968].

Rahhal H, Campos FPF, Ferreira CR, Felipe-Silva A. Lemierre’s syndrome due to intratumoral abscess of the uvula. Autops Case Rep. 2015;5(3):11-20. [].


Publication date:

5696402a5ce02ad87d000000 autopsy Articles

Autops Case Rep

Share this page
Page Sections